Rodríguez Jaime, Taboada Manuel, Valiño Cristina, Bárcena María, Alvarez Julián
Department of Anesthesiology, Hospital Clínico, Universitario de Santiago, Santiago de Compostela, Spain.
Reg Anesth Pain Med. 2006 May-Jun;31(3):202-5. doi: 10.1016/j.rapm.2006.01.002.
Radial plus musculocutaneous nerve stimulation may have a predominant role in the success of an axillary block, producing more extensive anesthesia of the upper limb than median plus musculocutaneous nerve stimulation. However, no comparison has been made with ulnar plus musculocutaneous nerve stimulation. We compared the extent of both sensory and motor block after ulnar plus musculocutaneous nerve stimulation or radial plus musculocutaneous nerve stimulation.
Sixty patients were randomly assigned to receive an axillary block using either radial plus musculocutaneous or ulnar plus musculocutaneous nerve stimulation with 40 mL plain 1.5% mepivacaine. Patients were assessed for sensory block by the pinprick method at 5 and 20 minutes.
No statistically significant differences were found in the rates of anesthesia at 20 minutes in the cutaneous nerve distributions of the upper limb between radial plus musculocutaneous and ulnar plus musculocutaneous nerve stimulation except for the following nerves: radial (90% and 63.3%, respectively), medial cutaneous of the forearm (83.3% and 100%, respectively), and medial cutaneous of the arm (73.3% and 93.3%, respectively). Global sensory score (minimum: 0; maximum: 12 points) at 20 minutes was significantly higher after radial plus musculocutaneous than after ulnar plus musculocutaneous nerve stimulation: 12 (11-13) and 11 (10-12), respectively. The rates of median nerve blockade were 50% and 53%, respectively.
Radial plus musculocutaneous nerve stimulation produced more extensive anesthesia of the upper limb than did ulnar plus musculocutaneous nerve stimulation. However, there is not an optimal combination of 2 responses in axillary brachial plexus block.
桡神经加肌皮神经刺激可能在腋路阻滞成功中起主要作用，与正中神经加肌皮神经刺激相比，能产生更广泛的上肢麻醉效果。然而，尚未将其与尺神经加肌皮神经刺激进行比较。我们比较了尺神经加肌皮神经刺激或桡神经加肌皮神经刺激后感觉和运动阻滞的范围。
60例患者被随机分配接受使用40毫升普通1.5%甲哌卡因的桡神经加肌皮神经或尺神经加肌皮神经刺激的腋路阻滞。在5分钟和20分钟时通过针刺法评估患者的感觉阻滞情况。
除以下神经外，桡神经加肌皮神经刺激和尺神经加肌皮神经刺激在上肢皮神经分布区域20分钟时的麻醉率无统计学显著差异：桡神经（分别为90%和63.3%）、前臂内侧皮神经（分别为83.3%和100%）、臂内侧皮神经（分别为73.3%和93.3%）。20分钟时桡神经加肌皮神经刺激后的总体感觉评分（最低：0分；最高：12分）显著高于尺神经加肌皮神经刺激后：分别为12（11 - 13）分和11（10 - 12）分。正中神经阻滞率分别为50%和53%。
桡神经加肌皮神经刺激比尺神经加肌皮神经刺激产生更广泛的上肢麻醉效果。然而，在腋路臂丛阻滞中不存在两种反应的最佳组合。
